(PS2-A17) Cognitive Behavioral Therapy for Panic Disorder Increases Emotional Self-efficacy

Background: Cognitive-behavioral therapy (CBT) is an effective and widely used treatment for panic disorder, but questions remain about the the mechanisms by which CBT has its effect on panic disorder. One potential mechanism that has yet to be studied is through changes in emotional self-efficacy (ESE). ESE refers to an individual’s confidence in their emotional functioning capabilities, including their ability to understand and manage their emotions (Kirk et al., 2008). ESE is relevant to panic disorder, as individuals with this condition often experience overwhelming emotions and misinterpret emotions as signals of threat. The aim of the present study is to investigate whether CBT for panic disorder is associated with gains in ESE and whether these gains are greater among individuals who exhibit reductions in panic symptoms (Baker et al. 2004; Strauss et al. 2019).

Methods: We examined the Emotional Self Efficacy Scale (ESES) scores and Clinical Global Impression (CGI) ratings for individuals (N = 41) receiving 7-sessions of CBT for panic disorder. We conducted repeated measures ANOVAs to determine if ESES scores (ESES total scores and the four individual factor scores) increased over time. Bonferroni-corrected pairwise comparisons were used to determine which time points were associated with significant change in ESES. An independent-samples t-test was used to evaluate whether those who showed significant clinical improvement in panic severity at post-treatment experienced more gains in ESES than those with little or no change.

Results: ESE increased over the course of CBT, F(2.55, 91.74)= 20.212, p< 0.001, GES = 0.086. Findings differed across ESES factors. Factors 1 and 2 (understanding and managing one’s own emotions, respectively) showed moderate to large effects (GES=0.123 and 0.107) whereas Factors 3 and 4 (perceiving and managing other’s emotions) showed small to medium changes (GES=0.015 and 0.055). Pairwise comparisons suggest that the gains in ESE tended to occur later in treatment, with the first statistically significant comparisons emerging after mid-treatment and persisting through the follow-up assessment. There was no evidence that change in ESES scores was a function of clinical improvement, as measured by the CGI-I, t(27.18)=-1.626, p=0.116.

Discussion: Patients receiving CBT exhibited significant gains in ESE, especially during the portion of treatment in which they were completing exposure therapy exercises, suggesting that this treatment component may contribute to the observed gains. Consistent with the focus of CBT for panic disorder, patients made larger gains in understanding and managing their own emotions than they did for other’s emotions. We did not find evidence that those who showed the most improvement in panic disorder severity also showed the largest gains in ESE. This finding should be interpreted with caution as relatively few individuals failed to exhibit significant clinical improvement, limiting our power to detect anything other than large differences between these groups. Future research should examine the components of therapy that lead to an increase in ESE and should test whether gains in ESE mediate the effect of CBT on panic disorder severity.